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Monthly Archives: March 2014

While sitting in the principal’s office discussing a program that I had stumbled upon for helping to lower the rates of and effectively managing school bullying (refer to my earlier blog), the principal exclaimed “Yes, but what can we do to help these kids ‘toughen up’?”. I replied with “Do you mean resilience?” and the principal said “Oh yes, sorry, I shouldn’t have said it like that”.

I explained to the principal that it was not right to put the onus on the child for managing school bullying and then added “but actually what does help victimized children cope is when other children intervene on their behalf to defend them because it gives them a sense of self-worth that someone would step in to defend them and helps to remove the blame attributed by themselves and others for the incident”.

There is a lot to be said for encouraging resilience in school children and it can be incorporated into the social and emotional learning curriculum for schools. I located two easy-to-read articles from a popular resilience program’s website that are worth a read (here and here). The latter of the two links provides advice to parents.

However, the dangers of focusing too heavily on resilience is that individual teachers may interpret that as an opportunity to put increasing pressure on children (including those with learning difficulties) to cope, without having a supportive curriculum or working on resilience-building strategies with the child (independent of the problem they are having difficulty with).

Let me give you an example of how insistence on resilience can be problematic. My son Damian has autism and among other challenges that he experiences he has trouble packing and unpacking his school bag. This is not uncommon among children with autism. In fact, I have autism and I find simple practical tasks very challenging but I excel with most theoretical academic tasks (as does Damian).

It doesn’t matter how many times I practice any given practical task, which I have greater than average difficulty with, the difficulty always remains to some degree. What would help me for some activities is to have a visual guide but then I’d have to create visual guides for all types of tasks and remember to carry them along with me at the right time so I have never bothered. Instead, I just take longer to get things done and ask people for help a lot. It’s something I am willing to live with.

My son’s teacher (Mrs L) created a visual guide for Damian to help him to unpack his school bag but the visual guide was still not enough to help him manipulate items such as his lunch box to fit well into his school bag and that was an issue that persisted for Damian when it came time to pack his school bag at the end of the school day.

Yesterday, when I went to collect Damian from school he was in tears and Mrs L came over to talk to me about it. Apparently, up until now, Mrs L and a few of Damian’s classmates had helped Damian to pack his bag at the end of the day but Mrs L had decided that it was time that he managed the task independently. Mrs L also said that Damian often becomes frustrated and upset when he has trouble packing his school bag and in saying so indicated that he should not be.

Mrs L then turned to Damian and said that it was time for him to pack his bag himself and that she would give him a ‘dollar coin’ token (a class reward) each time he was able to persist in completing the task without getting upset about it*. I use similar incentives at home for motivating my children to do things that they find boring or challenging (refer to my earlier blog for a discussion of token reward systems) so I added that I would also give him a token for his reward chart at home if he could do as Mrs L suggested.

This morning, I gave it a bit more thought and said to Damian that maybe Mrs L could let him pack up a few minutes earlier than everyone else but I could see when we practiced packing his bag that frustration would still occur regardless of the time given. So then I asked Damian what he thought might help and he suggested putting less in the school bag. Unfortunately, I had already minimized the items in his school bag as much as possible to allow more room for his lunch box. Then, I had a light bulb moment: ‘Why not have a separate lunch bag!”

My boys have collected lots of medium-sized backpacks over the years so we decided on using his ‘Auskick’ bag as an honorary lunch bag from now on. He would still be putting his lunch in a bag but a bag with no other objects in it to get in the way.

I was in a bit of rush and wrote a letter to Mrs L to explain. I was hoping that I wouldn’t have to give her the letter and could talk to her instead because I didn’t have the time to edit it and it was likely to come across as blunt but unfortunately Mrs L was absent. Instead, I had to leave the letter for Mrs L to read on her return and explain the other bag to the substitute teacher.

The letter follows:

Dear Mrs L,

I have been thinking about the ‘packing the bag’ situation with Damian. Damian and I have autism. One of the traits that Damian and I share (I assume) is with doing practical things with multiple steps. Believe it or not, I still have trouble using EFTPOS machines and filling the car with petrol. No amount of practice can rectify this. At Uni, I excelled in theory and flunked practical (well not really because my reports were well written but my experiments never worked and I was always last finished). So my solution to be accommodating to Damian’s diagnosis is to allow him to have a separate lunch bag. I have sent him to school with two lunch bags today. His usual bag and his ‘Auskick’ lunch bag. I’d like him to use the ‘Auskick’ lunch bag to pack his lunch in every day. Please let me know if this is a problem.

Thankyou for understanding

Rachel

So my point of all of this is that a child should not be asked to ‘not get upset’ when having difficulty with a task or situation because they need to be ‘more resilient’ and instead be provided with strategies and alternatives to manage the problem. If it is generally observed that the child gets upset easily with most things then applying strategies to improve their overall resilience without singling them out in the class (i.e. part of the curriculum) but at the same time always looking to problem solve, keeping in mind that each child has their own personal strengths and challenges and what is easy to manage and cope with for one child is not so for another.

*Mrs L did not use the words ‘be more resilient’ as such. Mrs L used the words ‘be more persistent’ and ‘not getting upset’, which roughly equates to the same thing. A good definition of resilience can be found here.

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I wasn’t going to post anything this week because I’ve been busy helping my mother prepare invitations for her wedding and making arrangements for Damian’s birthday party this Sunday. However when you have a morning like mine, it is too ‘good’ to miss writing about it.

Today is National Ride to School Day in Australia. After over a years worth of effort teaching and helping Damian overcome his anxiety about riding a bike (a story in itself), Damian can now ride his bike without training wheels with confidence and ease.

We don’t ride our bikes to school normally because we live too far away from school to do that (about 15 minutes drive) but in the spirit of the occasion we parked a suitable distance from school at the local skate park (about 3 km away from school) so that we could be part of this annual event.

The school staff encouraged all the children to take part and have offered points for each child participating in it to go towards their own school-house teams, with the winning team to be announced at the end of the day.

Two weeks ago, my husband, Jeremy, Damian and I did a practice ‘ride to school’ in preparation for the real thing. There was anxiety and tears from Damian about riding a small stretch of the way on a back road (the road safety messages have sunk in well), then anxiety about crossing a bridge from Jeremy who is somewhat afraid of heights, then arguments about who was to ride in front (both boys wanted to lead) and plenty of ‘when are we going to get there?’ general whining. Needless to say my husband decided to ride back to get the car so that we didn’t have to ride our bikes back again.

After our training ride, I suggested that we should wait another year before attempting the ‘ride to school’ because I didn’t think they were ready for it but both boys baulked at that and pleaded with me to do it, so I relented.

I was aware that my husband wouldn’t be able to help out on the day because of work commitments, which made me nervous. What if one of the boys refused to ride any further? Then I’d be stuck with one boy crying about wanting to continue and the other one crying about wanting to stop. I’ve been stuck in similar situations before. Unfortunately, my boys are not very flexible thinkers.

This morning, we got up earlier than usual to account for the extra time it would take to ride our bikes to school. We left 30 minutes later than I had planned because I decided to pump the bike tyres up a bit more and had trouble detaching my bike from its stand. I have a great deal of trouble with fiddly practical tasks. Such tasks are much more complicated for me than the average person. Fortunately, I always aim for an earlier departure time than necessary because I am anxious about being late for things.

It wasn’t until I went to pack the bikes into the car that I realised my bike wouldn’t fit. My husband usually attaches them to a rack on the back of the car whenever we take them somewhere and I was not about to try that this morning. I decided to take Jeremy’s scooter instead, there was no way I was going to attempt to run next to them like my husband does sometimes. My running days are long gone.

I parked the car at the skate park and we got on our bikes/scooter. Damian was still anxious about riding on the back road and started crying, so I told him to walk his bike to the track. Once I reassured him that there were not going to be any cars on the back road at this time in the morning on a week day (unlike the two that passed us on the weekend because it leads to a walking track) he decided to ride and his anxiety abated.

We actually managed to ride along at a better pace than for our training ride and I was feeling confident that we would get to school early. I gave the boys plenty of praise for riding so well. Damian was out in front because I was carrying his school bag so he was feeling very important and I was taking my time with Jeremy, swapping legs on the scooter each time my muscles started to cramp up (I’m not used to riding a scooter). Much to my delight both boys rode happily across the bridge without incident.

We were almost at the school when it happened. I hit a bump and toppled over the front of the scooter. I felt myself flying through the air in slow motion and consciously got my hands out in front as fast as I could to break my fall. I managed to belly flop on the concrete in front of me. I slowly sat up feeling a bit winded and realized that blood was dripping from my chin. I was very relieved that I hadn’t sprained or broken anything though. I was also glad it was me and not one of my boys.

While I was assessing the damage, Damian was up ahead and getting anxious that I wasn’t catching up to him. He started calling out for me in a distressed way. It rarely occurs to Damian for him to come to me. I call out to him to say that I’m coming and he needs to wait. Another mother (I’ll call her Susan) who was riding with her school child stopped and offered help. Fortunately, she had plenty of tissues because my chin wouldn’t stop bleeding. I realized pretty quickly that my arms and legs were unharmed, so I thanked Susan for the tissues, hoisted the scooter over my shoulder and walked with Jeremy towards Damian who was still crying out for me.

To cut a long story short, we walked the rest of the way to school (anxiously crossing roads). Susan found me as soon as we got to school and offered me a lift home (she would bring her car back to the school to collect me). I refused the offer twice but accepted on her third offer assuming she must really want to help me. My natural reaction to any form of help is to refuse; I’m never comfortable with it (unless it’s a service I’m paying for). I know it’s not healthy but that’s how I feel. Anyhow, I remembered my manners and thanked her kindly; she would be my hero for the day.

The first school bell rang as we put our bikes away. I was pretty pleased that we had arrived at school at just the right time. If anything I am usually prompt. I send Jeremy and Damian off to class with hugs and plenty of praise for their efforts and headed straight to the school’s first aid room before meeting Susan out the front of the school.

Plenty of teachers and parents were concerned for me, I laughed and they laughed and they commiserated. Several people offered to stay with me while I waited for my ride but I reassured them that I was fine. It was just my chin. But it wasn’t really just my chin because I was frustrated with myself. I couldn’t believe that I fell off my scooter on National Ride to School Day. But more to the point, I COULD believe it because it is the sort of thing only I could do. I’m clumsy at the best of times. I’m lucky to be alive really. Sigh.

I couldn’t help laughing after the doctor glued my chin and he warned me about the signs of concussion. He actually said “If you find yourself wandering around not knowing what you are doing, then come straight back”. If that is the case, I should visit a doctor every day. You know how it is, as a frazzled ‘stay at home mum’, when you walk into one room of the house and wonder what it was you planned to do there, three seconds earlier? That’s me, everyday.

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When the air is full of tension, when the frequency of fights begins to overwhelm, when you are not feeling so much love towards the behaviour of your children it is a wonderful time to stop whatever it is you are doing and play with them. But boy am I glad the days of imaginative play are over because now I can play a game of cards with them, play a board game, play poison ball on the trampoline or even just cuddle up on the couch and watch a kids movie together. All you need to do is spare the time and the results will save you time in the long run (reducing time spent disciplining them).

When I start playing with my boys I notice the smiles and laughter, their behaviour improves by a multiple of ten and my own blood pressure drops and mood improves. Big events like a family bike ride, baking (it’s big for us) or outings do not often achieve the same results for us because they present triggers for anxiety. Such activities are more rewarding when planned in advanced and well organised for a time when we are all fresh and energetic.

As for imaginative play, my children and I have autism and many health professionals have recommended that young children with autism be extended in this area because imaginative play is something that people with autism are proposed to lack in, although the results of imaginative and pretend play are variable among people with autism (Woodard 2011). I can see the value of imaginative play as being like role-play or a rehearsal for real life and therefore teaching valuable skills (social or other).

But honestly, as a general rule, I find imaginative play challenging in the sense that in order for it to be fun you have to really think outside the box. The amount of thought I have to put into it to be enjoyable has a high energy cost for me. Otherwise, imaginative play is just too boring to contemplate. I think I share this in common with my son Jeremy (unlike Damian) who is only ever interested in imaginative play when someone else is leading it. Jeremy is one of those kids who lines things up and catalogues things when playing alone. I don’t look at that as some kind of dysfunction. That kind of play has its benefits too. I consider us to be maths and science people.

However, when Jeremy was younger, I could see the benefit in imaginative play for him because if other kids were doing it, I wanted to make sure that he could understand the concept and join in at the very least. An occupational therapist, who had an interest in the area of imaginative play in children with autism, recommended the resource ‘Learn to Play’ for Jeremy. ‘Learn to Play’ is essentially a detailed step-by-step guide, with play scripts, on how to develop a child’s imaginative play skills for each developmental level. I did find it the resource useful so it may be of interest to you but honestly I also found it laborious.

Have you ever had a pretend cup of tea with your child? I have dozens of times, and I don’t even drink tea in real life. How many times can you blow on a hot cup of tea before you hyperventilate? I get bored and my boys detect when I am bored and it’s just not as much fun. Now if I had my way, I might be able to mimic (really dramatically) a waiter in a cafe, who spills the coffee before reaching you and has to clean it up and apologises profusely for the inconvenience and offers you a free coffee in compensation. When I (the waiter) go back to the kitchen (feeling really bad about my mistake), I debrief with a fellow waiter about what a terrible week I have had (what with my girlfriend breaking up with me and my bike being stolen and all). My waiter friend sympathizes with me and tells me not to worry about the spilt coffee saying that it’s ‘no big deal’ and offers me a ride home. Now, that’s a little more interesting.

Have you ever played doctors and nurses? I have dozens of times. I’ve had so many pretend x-rays that I would have developed pretend cancer by now. Now if I had my way, I might invent a new treatment for a previously incurable condition but patients would have to travel long distances and sell their houses and/or fundraise to pay the exorbitant fees involved. Post treatment and operation, patients would skip home (literally) after many weeks of rehabilitation singing my praises (literally singing) and grateful for a second chance at life, swearing that they will never complain about small problems like a stubbed toe or sprained ankle again (then turn around and stub their toe two weeks later and swear profusely about it).

Have you ever played families? I have dozens of times, and it’s actually a lot easier to script because I do it ‘day in and day out’. However, if I had my way (and from time- to- time I have had my way on this one), I might insist I play the role of the child because that’s a role I can have some fun with. I might complain that I am bored and beg to play the iPad, ignore requests to ‘get ready’ to go somewhere by being vague and continuing to play with my action figures or torment my brother until it ends in tears. Of course, my boys would get sick of that pretty quickly and insist I become the mother. Then they would give me a bit of karma in return and as ‘pretend mother’ I would decide that it was time to stop whatever pretend activity I was doing at the time and play a game of pretend cards with them and we’d all live happily ever after. Hey, it’s my pretend story OK.

Seriously though, if I need to teach my boys a particular social skill we might do a role play or rehearse it but as for ‘imaginative play as a therapy’ goes, those days are over for us and I could not be happier. The ‘Learn to Play’ resource was targeted at ages 5 years and below. Now, don’t even consider telling me (over a cup of tea for instance) about the existence of imaginative play resources for older age groups or I may just hyperventilate.

Reference:

Woodard, C.R. and Van Reet, J. Object identification and imagination: An alternative to the meta-representational explanation of autism. Journal of Autism and Developmental Disorders 2011; 41:213-226

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Previously , there was a personal story about my son here. I did not think to ask his consent to publish it at the time because he was five years old. It was about his anxiety with regard to the school cross country event and how we worked together to manage that anxiety successfully. I read the story to Damian today and he asked me to delete it but he wanted me to leave the picture of his artwork up here. I have retained the information on anxiety generally.

Autism and anxiety

Children with autism experience more anxiety than other children1;2;3. The rate of anxiety among children with autism increases with increasing IQ and functional communication3. The cause of the higher rates of anxiety is not fully understood but is likely to be multi-factorial.

My opinion is that the increased anxiety experienced by children with autism is due to a combination of increased social and sensory challenges and stigma. In addition, from my experience, I believe that expectations of self and others to behave ‘normally’ contribute to increased anxiety among people with autism especially those whose differences are less visible.

To help to manage the anxiety experienced by people with autism, cognitive behavioural therapy (CBT) is recommended for trial by scientists1;2. CBT is an evidence-based practise for reducing anxiety in general populations4;5 and recent evidence indicates that it also useful for reducing anxiety among children with autism1;6.

Lang et al. summarizes CBT very succinctly as ‘a) The patient is told the origin of their anxiety symptoms to help them realize that feeling anxious is not their fault. b) The therapist works with the client to help them realize the impact of anxiety and the need for change. c) A ranking of situations or stimuli from least to most anxiety producing is created. d) Clients are gradually exposed to the least producing anxiety situations/stimuli first while simultaneously learning to control their fear. e) The client is taught a variety of coping behaviours (eg. relaxation techniques) to help them manage their anxiety’6 .

Lang et al. recommends that CBT procedures for children with autism who do not have an intellectual disability be modified by ‘reducing the emphasis on abstract discussions of thoughts and feelings and by increasing the emphasis on the graduated exposure and teaching social skills as a coping mechanism. Additionally, rewards are given to improve compliance during treatment, visual aids are used as instructional tools, and the clients’ families are encouraged to participate. For individuals who also have an intellectual disability, graduated exposure and/or functional assessment followed by a function-based intervention is recommended’6 .

No-one can answer the question ‘avoid or enable?’ posed earlier, as a general rule. Many factors need to be taken into consideration in each case of anxiety for each child with advice from experts and those who know the child well. However, it is worth being aware that CBT, which discourages avoidance (with the understanding that avoidance may increase anxiety) may be useful for your child. A child psychologist with expertise in autism can give further advice on any unique situations that your child may face.

References:

1. Reaven, J and Hepburn, S. The parent’s role in the treatment of anxiety symptoms In children with high-functioning autism spectrum disorders. Mental Health Aspects of Developmental Disabilities 2006; 9(3): 1-7

5. Velting, O.N. Setzer, N.J. Albano, A.M. Update on and advances in assessment of cognitive behavioural treatment of anxiety disorders in children and adolescents. Professional Psychology: Research and Practice 2004; 35:42-54